28 Uncomfortable Symptoms of Pregnancy & Their Causes

Most pregnancies are medically uneventful and end happily in the birth of a healthy baby. Your first  and most important step is to sign up for a comprehensive prenatal program with an obstetrician (a doctor who specializes in pregnancy and childbirth) or a midwife. You and your developing baby will get routine monitoring to make sure everything is going well, and if it isn’t, you’ll get a referral for appropriate care. You will get reliable information about each stage of your pregnancy, including labor, childbirth, and the care and feeding of a newborn.

Pregnancy brings many changes to your body. And  you may wonder whether certain physical discomforts are serious enough for medical intervention or are minor problems you can deal with on your own. 

You’ll have various kinds of discomforts during pregnancy – some fleeting and others that last longer. Some may happen in the early weeks, while others emerge closer to the time of delivery. Still others may start early and then go away, only to return later.

Every person’s pregnancy is unique, so you may not have all of the changes described below.

Talk to your doctor if:

• You have severe nausea and vomiting, dehydration, a persistent rapid heartbeat, or pale, dry skin; you may have hyperemesis gravidarum, a severe form of morning sickness.
• You have vaginal spotting or bleeding; you may be having a miscarriage or serious placental complication.
• You have sudden weight gain over a few days, severe headache, or blurred vision; you may have preeclampsia, a form of high blood pressure that can endanger your health and the health of your baby.
• You have a fever over 100 F and chills, backache, or blood in your urine; you may have a kidney infection or other infection.
• After the baby begins to move, you feel less or no movement for more than 2 hours; your doctor will check to see if the baby is OK.
• You feel wetness or a leaking of fluid, unlike normal vaginal discharge or urinary leakage; you may have ruptured membranes or leaking of amniotic fluid.

Most pregnant women will feel some changes in their breasts. Your breasts will get bigger as your milk glands enlarge and the fat tissue enlarges, causing breast firmness and tenderness, typically during pregnancy’s first and last few months. Bluish veins may also appear as your blood supply increases. Your breasts might leak a yellowish fluid called colostrum, usually during the third trimester. Colostrum is the “pre-milk” that will nourish your baby in the first days of life until your milk comes in. As you get closer to delivery, it changes to a thin, colorless liquid.

Your nipples can also darken. They may stick out more, and the areolas may get bigger. Small glands around the nipples become raised. They make oil to keep your nipples soft. These changes make it easier for your baby to find and latch onto your nipples for breastfeeding.

The freckles and moles on your body may be darker, too. Talk to your doctor if you have a mole or freckle that is growing, changing color and shape, itching or bleeding, or larger than a pencil eraser. These may be signs of skin cancer.

Recommendations:

•  Wear a bra that provides firm support.
•  Choose cotton bras or those made from other natural fibers.
•  Get a bigger bra as your breasts become larger and fuller. Your bra should fit well without irritating your nipples. Try maternity or nursing bras, which provide more support and can be used after pregnancy if you choose to breastfeed.
•  Try wearing a bra during the night.
•  Tuck a cotton handkerchief or gauze pad into each bra cup to absorb leaking fluid. You can also buy nursing pads in the drugstore or maternity/baby store that fit into your bra. Make sure to change these pads as needed so your skin doesn’t get irritated.
•  Wash your breasts with warm water and mild soap that will not cause dryness.

Feeling tired? That might be because your growing baby requires extra energy. Sometimes, it’s a sign of anemia (low iron in the blood), which is common during pregnancy.

Recommendations:

• Get plenty of rest. Go to bed earlier and take naps.
• Keep a regular schedule when possible.
• Pace yourself. Balance activity with rest.
• Moderate exercise daily boosts your energy level.
• Ask your health care provider to test your blood routinely for anemia.

It’s very common and normal to have an upset stomach when you’re pregnant.

Chalk it up to pregnancy’s hormonal changes. It usually happens early in pregnancy, while your body is adjusting to the higher hormone levels.

Good news: Nausea usually disappears by the fourth month of pregnancy (although in some cases it can persist throughout the pregnancy). It can happen at any time of the day but may be worse in the morning, when your stomach is empty (that’s why it’s called “morning sickness”) or if you aren’t eating enough.

Recommendations:

• If nausea is a problem in the morning, eat dry foods like cereal, toast, or crackers before getting out of bed. Try eating a high-protein snack such as lean meat or cheese before going to bed. (Protein takes longer to digest.)
• If you are hungry but extremely nauseated, try the BRAT (bananas, rice, and tea) diet as well as bland foods.
• Acupressure wristbands offer some pregnant women comfort.
• Ginger may combat nausea.
• Eat small meals or snacks every 2 to 3 hours rather than three large meals. Eat slowly, and chew your food completely.
• Sip on fluids throughout the day. Avoid large amounts of fluids at one time. Try cool, clear fruit juices, such as apple juice or grape juice.
• Avoid spicy, fried, or greasy foods.
• If you are bothered by strong smells, eat foods cold or at room temperature to minimize or avoid odors that bother you.
• Talk to your doctor about taking vitamin B6. Other natural treatments and prescription medications can provide relief.
• Contact your health care provider if your vomiting is constant or so severe that you can’t keep fluids or foods down. This can cause dehydration and should be treated right away.

Diarrhea usually doesn’t mean anything is wrong. But it can be distressing. It may be related to your prenatal vitamin or your attempts to eat better, or it could just be a bug you caught. In any case, when diarrhea strikes during pregnancy, it’s even more important to take good care of yourself.

Call your doctor if the diarrhea is serious or lasts more than 24 hours, if you get dehydrated or dizzy, if the stool has blood or pus, if it’s black and tarry, if you also have a fever or severe belly pain, or if you think medication might help ease your symptoms.

Recommendations:

• Eat bland, soft, and low-fiber foods such as bananas, rice, toast, mashed potatoes, yogurt, or cottage cheese.
• Drink plenty of water and electrolyte drinks such as Gatorade or Pedialyte to replace lost fluids. (If you have gestational diabetes, check with your doctor first.) It’s especially dangerous to become dehydrated during pregnancy. Dehydration can trigger preterm contractions.

Your pants may feel tight even if you’re not that far along. Blame hormone changes. Early in pregnancy, rising progesterone can cause your digestive system to slow and your smooth muscle tissue to relax. This can cause bloating. It’s similar to what happens to many women right before their period starts.

Recommendations:

• Do gentle exercise, such as walking or swimming, which helps keep the digestive system moving.
• Drink water throughout the day to help digestion.
• Eat smaller meals more often. It’s easier on the digestive system.
• Eat foods high in fiber, such as fruits, vegetables, and whole grains.

It’s normal to have to pee a lot when you’re pregnant. Early in your pregnancy, your body makes a hormone that may increase urination. Your growing uterus and baby also press against your bladder. The pressure can wake you up several times a night to go to the bathroom. You may also have the urge to go even when your bladder is almost empty. This problem usually goes away a few days after your baby is born.

Call your doctor if you have a fever or blood in your urine, or if you have the urge to go again just after you’ve emptied your bladder. If it hurts, burns, or stings when you pee, you could have a urinary tract infection. This needs treatment right away.

Recommendations:

• Don’t wear tight-fitting underwear, pants, or pantyhose.
• Drink plenty of fluids to avoid dehydration. Try to get them mostly during the day. Drink less in the evening and at night. This should help you cut back on nighttime bathroom visits.
• Avoid coffee, tea, colas, and other caffeinated drinks. These can make you urinate more often.

Headaches can happen anytime during pregnancy. They can be caused by tension, congestion, constipation, or in some cases, preeclampsia (detected after 20 weeks).

Recommendations:

• Put an ice pack on your forehead or the back of your neck.
• Rest, sit, or lie quietly in a low-lit room. Close your eyes and try to relax your back, neck, and shoulders.
• Over-the-counter acetaminophen may help. But if your headaches don’t go away, are severe, make you nauseated, or affect your vision, tell your doctor.

You may not have expected pregnancy to affect your mouth. But your blood circulation and hormone levels can make your gums tender and swollen, and you may notice they bleed more easily. You may also get nosebleeds.

Recommendations:

• Get a dental checkup early in your pregnancy to make sure your teeth and mouth are healthy. See your dentist if you notice a particular problem.
• Brush your teeth, floss regularly, and rinse daily with an antiseptic mouthwash.

Your hormones, as well as vitamins and iron supplements, may cause constipation (trouble pooping or incomplete or infrequent passage of hard stools). Pressure on your rectum from your uterus may also cause constipation.

Call your doctor if you also have belly pain or rectal bleeding. If iron supplements are causing constipation, they may recommend a different one.

Recommendations:

•  Add more fiber (such as whole-grain foods, fresh fruits, and vegetables) to your diet.
•  Drink plenty of fluids daily (at least 6-8 glasses of water and 1-2 glasses of fruit or prune juice).
•  Drink warm liquids, especially in the morning.
•  Exercise daily. Walking and swimming are activities that are gentle on your pregnant body.
•  Avoid straining when you have a bowel movement.
• Talk with your doctor about a laxative or stool softener.

You might be surprised that carrying a baby could cause pain in your wrist. But up to 35% of women get pain or weakness in their wrist during pregnancy, usually in the third trimester. Fluid retention puts more pressure on the carpal tunnel, which runs from your wrist to the bottom of your palm. Most likely, the pain will get better within a few months of your baby’s birth.

Call your doctor if you have numbness, tingling, or pain in your hand or wrist, or if you have pain or strange sensations traveling up your arm to your shoulder.

Recommendations:

• Do range-of-motion exercises that stretch your wrist.
• Apply ice for pain.
• Avoid repetitive wrist and hand motions, or positions or activities that make pain or numbness worse. Wear a wrist splint if your job requires repetitive motions.
• If computer work is causing pain, adjust your chair or keyboard height to change the position of your wrists.
• Wear a wrist splint to bed if you have pain at night. It keeps your wrists from curling while you sleep, which contributes to pain.

Dizziness can occur anytime during middle to late pregnancy. Here’s why it happens:

• The hormone progesterone dilates blood vessels, so blood tends to pool in the legs.
• More blood is also going to your growing uterus. This can cause a drop in blood pressure, especially when changing positions – and that can make you dizzy. If your blood sugar levels get too low, you may feel faint.

Recommendations:

• Move around often when standing for long periods of time.
• Lie on your left side to rest. This helps circulation throughout your body.
• Avoid sudden movements. Move slowly when standing from a sitting position.
• Eat regular, small meals throughout the day to prevent low blood sugar.
• Drink plenty of water.

Finding a comfortable resting position can become difficult later in pregnancy. And your ballooning belly and bathroom breaks aren’t the only things keeping you up. From backaches to heartburn to anxiety, a wide range of concerns can affect slumber. Hormones can also disrupt your sleep patterns, leaving you exhausted by day and wide awake by night.

Even though you may not be sleeping well, now is when you need sleep the most. Your body needs to rest so it can feed and house your growing baby.

Recommendations:

• Don’t take sleep medication.
• Try drinking warm milk at bedtime.
• Take a warm shower or bath before bedtime.
• Use extra pillows for support while sleeping. Lying on your side, place a pillow under your abdomen, behind your back, and between your knees to prevent muscle strain and help you get the rest you need.
• Use blocks to prop up the head of the bed a few inches. This can ease breathing and help prevent any backflow of stomach acid from reflux.
• You will probably feel better lying on your left side; this improves circulation of blood throughout your body.  Sleep with bent knees to take pressure off your back.
• Exercise. Every day, try to take a 30-minute walk or a pregnancy exercise class. Staying active can help you sleep better. Just do it early in the day. Exercising within 4 hours of bedtime can be stimulating enough to keep you up.
• Relax before bed. Try a pregnancy yoga video or some deep-breathing exercises.
• Stretch. Do a few leg stretches to keep your legs from cramping during the night.
• Limit drinks. Stop drinking within 2 or 3 hours of bedtime so you won’t have to get up and go to the bathroom in the middle of the night.
• Avoid late meals as well as spicy, greasy, or acidic foods close to bedtime.
• Pee before sleeping. Make one last trip to the bathroom before you turn out the light.
• Turn down the thermostat. You’re going to feel warmer now because extra blood is rushing to your skin. Keeping your bedroom cool will make you more comfortable and prevent you from having to kick off the covers in the middle of the night.

Heartburn is a burning feeling that starts in the stomach and seems to rise up to the throat. During pregnancy, changing hormone levels slow down your digestive system, weaken the stomach sphincter, and your uterus can crowd your stomach, pushing stomach acids upward.

Recommendations:

• Eat several small meals each day instead of three large meals.
• Eat slowly.
• Drink warm liquids.
• Avoid fried, spicy, or rich foods, or any foods that seem to give you indigestion.
•  Don’t lie down right after eating.
•  Keep the head of your bed higher than the foot of your bed. Or place pillows under your shoulders to prevent stomach acids from rising into your throat.
•  Don’t mix fatty foods with sweets in one meal, and try to separate liquids and solids at meals.
• Try heartburn relievers such as Gaviscon, Maalox, Mylanta, Riopan, Titralac, or Tums.

Hemorrhoids are swollen veins that appear as painful lumps on the anus. During pregnancy, they may form as a result of increased circulation and pressure on the rectum and vagina from your growing baby.

Recommendations:

• Try to avoid constipation. Constipation can cause hemorrhoids and will make them more painful.
• Avoid sitting or standing for long periods of time; change your position frequently.
• Don’t strain during a bowel movement.
• Apply ice packs or cold compresses to the area, or take a warm bath a few times a day to provide relief.
• Avoid tight-fitting underwear, pants, or pantyhose.
• If you still need more help, consult your health care provider.

Pregnancy hormones may cause the walls of your veins to weaken and swell. Pressure on the veins behind your uterus also slows the circulation of blood to your heart, making the smaller veins in your pelvis and legs swell. You’re most likely to get these bluish, swollen veins in your legs. But in late pregnancy, they may appear in your vulva, the area outside your vagina. Varicose veins will probably get better after your baby is born, when pressure on your veins goes away.

Call your doctor if the veins feel hard, warm, or painful, or if the skin over them looks red.

Recommendations:

Although varicose veins usually run in families, these things might help:

• Avoid standing or sitting in one place for long periods. It’s important to get up and move around often.
• Avoid remaining in any position that might restrict the circulation in your legs (such as crossing your legs while sitting).
• Elevate your legs and feet while sitting.
• Exercise regularly.
• Wear support hose. Avoid socks or knee-highs that are too tight or constraining.
•  Sleep or rest on your left side to ease pressure on the vein that carries blood from your feet to your heart. It’s on your right side.

Pressure from your growing uterus can cause leg cramps or sharp pains down your legs.

Recommendations:

• Be sure to eat and drink foods that are rich in calcium (such as milk, broccoli, or cheese).
• Wear comfortable low-heeled shoes.
• Try wearing support hose, but avoid any leg wear that is too tight.
• Elevate your legs when possible; avoid crossing your legs.
• Exercise daily.
• Stretch your legs before going to bed.
• Avoid lying on your back, since the weight of your body and the pressure of your enlarged uterus can slow the circulation in your legs, causing cramps.
• Gently stretch any muscle that becomes cramped by straightening your leg, flexing your foot, and pulling your toes toward you.
• Massage the cramp or apply heat or a hot water bottle to the sore area.

You may have a stuffy nose or feel like you have a cold. Pregnancy hormones sometimes dry out the nose’s lining, making it inflamed and swollen.

Recommendations:

• Apply a warm, wet washcloth to your cheeks, eyes, and nose to reduce congestion.
• Avoid using nasal sprays unless prescribed by your doctor because they can aggravate your symptoms.
• Drink plenty of fluids (at least 6-8 glasses of fluids a day) to thin mucus.
• Elevate your head with an extra pillow while sleeping to prevent mucus from blocking your throat.
• Use a humidifier or vaporizer to add moisture to the air.
• Take a warm shower or bath.
• Get vaccinated against the flu. When you’re pregnant, you’re more likely to get sick and have serious complications, compared to when you’re not pregnant.

Shortness of breath can happen due to increased upward pressure from the uterus and changes in lung function.

Recommendations:

• When walking, slow down and rest a few moments.
• Raise your arms over your head (this lifts your rib cage and allows you to breathe in more air).
• Avoid lying flat on your back, and try sleeping with your head elevated.
• If prolonged shortness of breath continues or you have sharp pain when inhaling, contact your health care provider. You could have a pulmonary embolism (blood clot in the lungs).

Stretch marks are a type of scar tissue that forms when the skin’s normal elasticity is not enough for the stretching that occurs during pregnancy. They usually appear on the belly and can also appear on the breasts, buttocks, or thighs.

Though they won’t disappear, stretch marks will fade after delivery. Stretch marks affect the surface under the skin and are not preventable.

Recommendations:

• Be sure that your diet contains enough sources of the nutrients needed for healthy skin (especially vitamins C and E).
• Apply lotion to your skin to keep it soft and reduce dryness.
• Exercise daily.

Pressure from your growing uterus on the blood vessels carrying blood from the lower body causes fluid buildup. The result is swelling (edema) in the legs and feet.

Extra weight during pregnancy can also make your feet bigger. Plus, pregnancy hormones loosen your ligaments and muscles so your pelvic joints open up to get ready for childbirth. This affects your whole body, even your feet. Call your doctor if any swelling is more than mild or if it suddenly gets worse.

Recommendations:

• Try not to stay on your feet for long periods of time. Avoid standing in one place.
• Drink plenty of fluids (at least 6-8 glasses of fluids a day).
• Avoid foods high in salt (sodium).
• Elevate your legs and feet while sitting. Avoid crossing your legs.
• Wear loose, comfortable clothing; tight clothing can slow circulation and increase fluid retention.
• Soak your feet in cool water.
• Keep moving. Exercise your legs to keep fluid from building up.
• Don’t wear tight shoes; choose supportive shoes with low, wide heels.
• Keep your diet rich in protein; too little protein can cause fluid retention.
• Notify your health care provider if your hands or face swell. This may be a warning sign of preeclampsia.
• Rest on your side during the day to help increase blood flow to your kidneys.

This won’t happen in most pregnancies. But pregnancy does mean a greater chance of developing a blood clot.

A blood clot in the calf may lead to pain or swelling and can result in a blood clot that travels to the lung, which could be fatal.

A blood clot in the brain may bring a severe headache. But there are other possible causes of bad headaches during pregnancy.

Recommendation: If you have a history of blood clots, or if you get a severe headache, consult your doctor.

Vaginal bleeding during pregnancy: Call your obstetrician if you have spotting or bleeding at any point during your pregnancy. It’s more likely to be serious if it’s heavy bleeding or if it happens later during pregnancy. But call your doctor, regardless. 

Other vaginal discharge: It’s normal for this to increase when you’re pregnant. It happens due to greater blood supply and hormones. Normal vaginal discharge is white or clear, isn’t irritating, is odorless, and may look yellow when dry on your underwear or panty liners.

Recommendations:

• Choose cotton underwear or brands made from other natural fibers.
• Avoid tight-fitting jeans or pants.
• Do not douche. Douching can introduce air into your circulatory system or break your bag of waters in later pregnancy.
• Clean the vaginal area often with soap and water.
• Wipe yourself from front to back.
• Contact your health care provider if you have burning, itching, irritation or swelling, a bad odor, bloody discharge, or bright yellow or green discharge. (These symptoms could be a sign of infection.)

Backaches are usually caused by the strain put on the back muscles, changing hormone levels, and changes in your posture.

Recommendations:

• Wear low-heeled (but not flat) shoes.
• Avoid lifting heavy objects.
• Squat with your knees bent when picking things up instead of bending down at the waist.
• Don’t stand on your feet for long periods. If you need to stand for long periods, place one foot on a stool or box for support.
• Sit in a chair with good back support, or place a small pillow behind your lower back. Also, place your feet on a footrest or stool.
• Check that your bed is firm. If needed, put a board between the mattress and box spring.
• Sleep on your left side with a pillow between your legs for support.
• Apply a hot water bottle or heating pad on low setting to your back, take a warm bath or shower, or try massage.
• Perform exercises, as advised by your health care provider, to make your back muscles stronger and help relieve the soreness.
• Maintain good posture. Standing up straight will ease the strain on your back.
• Contact your health care provider if you have a low backache that goes around your stomach and does not go away within one hour after you change position or rest. This might be a sign of premature labor.

Sharp, shooting pains on either side of your stomach may result from the stretching tissue supporting your growing uterus. These pains may also travel down your thigh and into your leg.

Recommendations:

• Change your position or activity until you are comfortable; avoid sharp turns or movements.
• If you have a sudden pain in your belly, bend forward to the point of pain to relieve tension and relax the tissue.
• Apply a hot water bottle or heating pad to your back, or take a warm bath or shower.
• Try a massage.
• Make sure you are getting enough fluids.
• Take acetaminophen now and then.Follow the dosing instructions on the label.
• Contact your health care provider if the pain is severe or constant, or if you are less than 36 weeks pregnant and you have signs of labor. (Signs of labor include repetitive cramping like contractions.)

If you have certain medical conditions – such as thyroid disease, diabetes, high blood pressure, asthma, and/or lupus – note any changes in your condition during pregnancy and tell your doctor about them. It’s important to have those conditions under good control, for the sake of your health and your baby’s health. 

For example, people with diabetes whose blood sugar levels get too high may be more likely to have a miscarriage. And if you have high blood pressure while pregnant, the baby may be more likely to be born preterm (before 37 weeks of pregnancy) . 

Recommendation: Be sure to keep up with managing any conditions, ideally starting before you conceive and throughout your pregnancy.  

The uterine muscles will contract (tighten) starting as early as the second trimester of pregnancy. Irregular, infrequent contractions are called Braxton-Hicks contractions (also known as “false labor pains”). These are normal during pregnancy.

Recommendations:

• Try to relax
• Change positions. Sometimes this can ease the contractions.
• Call your doctor if they do not go away.

What does it mean if your baby has been active but now seems to have less energy? It may be normal. But how can you tell?

Call your doctor right away if you notice a big change in how much your baby is moving. Your doctor has monitoring equipment that can be used to determine if the baby is moving and growing well.

You’ll want to be aware of what is normal for your baby. There’s no hard and fast number of times that you should feel the baby kick or move. But you’ll want to know what’s typical for your baby and reach out to your obstetrician if you notice a big change in how active the baby is.

To get to know your baby’s patterns, you can count the number of kicks that happen in an hour. Or, you can measure how long it takes for your baby to kick 10 times. Some experts recommend calling your doctor if you haven’t felt at least 10 kicks within 2 hours to check on the baby.

When you’re pregnant, your enlarged uterus can put pressure on your bladder. That could lead to a urine leak, which you might mistake for your water breaking in a more subtle, less dramatic way than you might have expected. (It’s not always a big gush of fluid.)

One way to tell the difference is to go to the bathroom and pee. After your bladder is empty, if you’re still noticing fluid, your water has broken. Call your doctor or go to the hospital. 

Folic acid side effects and how to avoid them

Common folic acid side effects | Serious side effects | Allergic reactions | Seizures | Side effects timeline | Contraindications | Warnings | Interactions | How to avoid side effects | How to treat side effects

Folic acid (or folacin) is a synthetic form of folate, an essential nutrient also known as vitamin B-9. Folate is found in leafy green vegetables, fruits, cereals, and grain products, but some people may need to take folic acid supplements. Healthcare providers may prescribe folic acid as a tablet or injection for certain types of anemia, or for people who are malnourished, young, or pregnant. 

The body needs folate to grow new cells. This includes skin, hair, and, most importantly, blood. Large red blood cells (megaloblastic anemia) are often the first serious consequence of a folic acid deficiency. Folate is also important to the development of a fetus, particularly for the nervous system. A folate deficiency early in pregnancy could cause serious birth defects such as spina bifida and anencephaly. Folic acid supplements are strongly encouraged during pregnancy. Side effects of folic acid supplements are relatively rare and mild. 

Common side effects of folic acid

Side effects due to folic acid are rare. Hypersensitivity reactions may include:

• Skin rash or redness
• Itching
• Feeling bad
• Trouble breathing

Digestive system problems have also been reported in people taking high-dose folic acid. Though rare, these include:

• Appetite loss
• Nausea
• Flatulence
• Bloating
• Taste changes

Other rare adverse effects reported by people taking high-dose folic acid include:

• Irritability
• Excitement
• Overactivity
• Depression
• Sleep problems
• Confusion
• Difficulty concentrating

Serious side effects of folic acid

The most serious side effects of folic acid are allergic reactions. These include:

• Airway closure (bronchospasm)
• Anaphylaxis

Folic acid and allergic reactions

Though rare, the most common side effects are allergic reactions to folic acid or some other ingredient in the supplement. The incidence has not been determined. Some have only been reported in people taking excessively high doses of 15 mg or more, which is 35 times the recommended daily allowance. 

Folic acid and seizures

There is a myth that folic acid might cause seizures. Seizures can occur rarely when large doses of folic acid are taken by people with epilepsy who are also taking primidone, phenobarbital, phenytoin, or diphenylhydantoin. In these cases, the seizures are due to a drug interaction that lowers the level of antiseizure medication in the body. The seizures are not a side effect of folic acid itself. On the contrary, people taking antiepileptic drugs frequently have low folate levels in their blood. Folic acid supplementation has been shown to improve seizure control.

How soon do folic acid side effects start?

Since many of the side effects of folic acid are allergic reactions, they typically start early in treatment or right after taking a pill or getting an injection. Digestive system problems also tend to occur within the first month of high-dose folic acid treatment. However, mood problems, depression, and confusion are usually delayed reactions.

How long do folic acid side effects last?

Hypersensitivity reactions will continue for as long as folic acid—or a particular folic acid product—is used. They may even worsen if the supplement isn’t stopped. Side effects caused by high-dose folic acid therapy should clear up when doses are returned to normal.

What are the long-term side effects of folic acid?

Prolonged use of folic acid supplements could reduce the levels of vitamin B12 (cobalamin) in the blood. In addition, prolonged folic acid use can hide the symptoms of vitamin B12 deficiency. Like folate, cobalamin is vital to the growth and reproduction of cells. A cobalamin deficiency can lead to pernicious anemia, the condition that helps healthcare professionals diagnose a B12 deficiency. But a B12 deficiency can also permanently damage nerves and the spinal cord. Prolonged use of folic acid can cover up pernicious anemia, so the damage to the nervous system caused by a B12 deficiency could continue undetected.

Folic acid contraindications

Folic acid is never given to people who are allergic to it.

Pregnancy

Folic acid is not only safe to take by pregnant women, but it is strongly recommended. Folate is so important to the neural development of a fetus, the CDC suggests that women of childbearing age get at least 400 micrograms (mcg) of folate per day either by eating fortified foods or taking folic acid supplements. A healthcare provider may suggest a higher intake of folate before conception and during pregnancy. In women who have been pregnant with a fetus that had neural tube defects, the CDC suggests 4,000 mcg (4 mg) per day for one month before anticipated conception and for three months after conception.

RELATED: Why pregnant women need to take folic acid

Breastfeeding

Folic acid is safe and recommended while breastfeeding. Recommendations may vary, but the minimum intake should be 400 mcg per day. Since folate is present in breast milk as a vital nutrient for the nursing infant, some healthcare professionals recommend a higher daily intake to make up for the folate being lost in the milk. Folate from the diet is present in human breast milk, but so is folic acid taken in supplements. Like folate, folic acid is considered nontoxic for the nursing child. 

Children

It is safe to give children folic acid supplements following recommended guidelines. Prescription folic acid is approved by the U.S. Food and Drug Administration (FDA) in children as young as 1 month old.

Seniors

People older than 65 can take over-the-counter and prescription folic acid safely if they follow recommended guidelines or the instructions of a healthcare provider.

Folic acid warnings

Since folic acid is not toxic, it has only a few warnings and cautions.

Cautions

Because folic acid can mask pernicious anemia due to a vitamin B12 deficiency, healthcare providers are unlikely to prescribe folic acid supplements to people with a vitamin B12 deficiency, pernicious anemia, or undiagnosed anemia. 

People who are considering over-the-counter folic acid supplements should take the recommended daily allowance of 400 mcg per day. They should also make sure to take the recommended daily allowance of vitamin B12. Anyone who suspects they have some type of anemia or vitamin deficiency should get medical advice from a healthcare professional before taking supplements.

Abuse and dependence

Folic acid does not cause physical dependence or withdrawal. Some people do take high doses of vitamins for a variety of motivations, but this is not considered drug abuse. 

Overdose

Call a poison control center or get emergency medical attention if too much folic acid is taken. Except under the instructions of a healthcare professional, the maximum daily folate intake should not exceed 400 mcg. 

Folic acid interactions

Although folic acid is a vitamin, it does have a few important drug interactions. Most are mild, but healthcare providers may have to adjust doses or find other treatments.

• Seizure medications: Folic acid reduces the concentrations of certain types of anticonvulsants in the body, making seizures more likely.

• Alcohol: Alcohol partly blocks the ability of the intestines to absorb folic acid. Many people who abuse alcohol have folate deficiency.

• Bile acid resins: Like alcohol, bile acid sequestrants used to treat high cholesterol reduce the body’s absorption of folic acid through the intestines.

• Methotrexate: Folic acid can reduce the effectiveness of the immune suppressant methotrexate. However, because folic acid competes with methotrexate, folic acid supplements are sometimes prescribed with methotrexate in people with rheumatoid arthritis or to prevent methotrexate side effects like mouth sores.

How to avoid folic acid side effects

Folic acid is generally taken without problems, but it pays to take a few steps to be extra safe.

1. Follow the directions

Don’t make up your own dosage to take. Take what the bottle, package insert, or healthcare provider tells you to take. It may seem smart to take “extra”—how could it hurt, right?—but it’s not. At best, the extra folic acid won’t do much good. At worst, it may cause long-term problems.

2. Don’t exceed the recommended daily allowances when taking vitamin supplements

Some people take folic acid supplements in combination with other vitamins and minerals including B-complex vitamins. Before taking these combination vitamins, research the recommended dietary allowances (RDA) of all the vitamins and minerals in the products and follow those guidelines. 

3. Don’t take prescription doses of folic acid using multivitamins

A healthcare provider may suggest taking more than 400 mcg per day or prescribe a higher amount of folic acid. If that happens, don’t try to increase your folic acid intake by taking multivitamins or B-complex vitamins. Taking too many of those other vitamins or minerals could cause side effects.

4. Tell the prescriber about all medical conditions and medications

If a healthcare professional prescribes folic acid supplements, make sure to tell the prescriber about any prescription drugs, over-the-counter medications, supplements, and pre-existing medical conditions , particularly:

• Seizure disorders
• Anemia
• Alcoholism
• Liver disease
• Kidney problems

5.

Consider filling a prescription

If a healthcare professional prescribes folic acid, consider filling that prescription rather than buying over-the-counter folic acid. Prescription supplements meet higher standards of quality and reliability. For all practical purposes, you don’t know what is contained in an over-the-counter supplement. If prescription folic acid is too pricey, use a SingleCare discount card or ask the prescriber to identify the most reliable over-the-counter folic acid supplements.

6. Take folic acid with food

To avoid digestive system issues, take each folic acid supplement during or after a meal.

7. Avoid drinking alcohol

Alcohol reduces the body’s ability to absorb folic acid, so it doesn’t make much sense to drink and take folic acid supplements. If taking prescription folic acid, take a break from drinking until treatment is over.

How to treat side effects of folic acid

Side effects of folic acid are rare, except in cases of people taking high doses. Unless high doses have been prescribed, don’t take more than the recommended daily allowance.

Nausea 

Nausea can be handled by rest. An antihistamine or other anti-nausea drug could help. If nausea is accompanied by vomiting, drink fluids in small amounts to prevent dehydration.

Bloating 

Eat small meals, exercise, and drink more fluids if experiencing bloating, abdominal distention, or excess gas when using folic acid supplements. If taking over-the-counter folic acid, consider switching to a different product.

Allergic reactions 

If an allergic reaction is experienced while taking prescription or over-the-counter folic acid dietary supplements, stop taking the supplement and get medical attention. Symptoms include:

• Skin redness
• Skin rash
• Hives
• Itching
• Shortness of breath
• Swollen face, neck, mouth, or throat

Sources

• Disturbances of folic acid and homocysteine metabolism in alcohol abuse, Polski merkuriusz lekarski
• Effect of folic acid supplementation on seizure control in epileptic children receiving long-term antiepileptic therapy, Indian Journal of Pediatrics
• Folic acid, Centers for Disease Control and Prevention (CDC)
• Folic acid, Epocrates
• Folic acid and epilepsy, Epilepsy Currents
• Folic acid tablets drug summary, Prescriber’s Digital Reference
• Folic acid tablet prescribing information, U. S. National Library of Medicine

Do you need to take folic acid supplements? Here are three important benefits｜ iHerb Blog

The information in this blog has not been verified by your country’s public health authority and is not intended as a diagnosis, treatment, or medical advice.
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Folate is involved in many important processes in the body, including cell division, the formation of DNA nitrogenous bases, and the development of red blood cells.

Green leafy vegetables (eg spinach, lettuce and broccoli) are rich in folate. It is also found in lean meat, milk and eggs. Despite its presence in many foods, dietary intake of folate usually does not reach the recommended daily allowance.

In this article, we will look at the importance of taking folic acid supplements.

What is folic acid?

Folic acid is a synthetic form of natural folate (vitamin B9). It is an essential vitamin, meaning our body cannot produce it on its own and must be obtained from food.

Folate is a water-soluble vitamin involved in the biosynthesis of genetic material. It is intensively involved in the process of cell division from the moment of conception and is necessary to maintain a normal level of red blood cells in the blood.

Comparison of folic acid and folate

Folic acid and folate are equally used by the body. Folate generally refers to the natural form of the vitamin found naturally in foods. Folic acid is also used in supplements and specially fortified foods, such as pasta, bread, and some cereals.

One reason for using folic acid (rather than folate) in supplements and fortified foods is its greater stability. Folate breaks down quickly when exposed to light and heat, making it difficult to add to many foods and supplements. Folic acid is readily absorbed by the body, and studies have shown that folate levels in the blood increase in different populations when taken.

‌‌Three Important Functions of Folate in the Body

Folate is required for various essential physiological processes.

Restoration of genetic material

Folate is essential for the synthesis and repair of genetic material, including DNA. For example, when unprotected skin is exposed to sunlight, ultraviolet radiation can seriously damage the genetic material of skin cells. After that, folate helps to repair the damage done by adding a methyl group to the nitrogenous bases of the DNA.

Cell division support

All cells in the body are constantly dividing, whether they are oral, intestinal, red blood cells or immune cells. Folic acid ensures normal cell division and accurate copying of genetic material.

Supports protein synthesis and RBC maturation

Folic acid helps the body convert homocysteine ​​to methionine, an amino acid involved in protein synthesis. Finally, folic acid supports the maturation of red blood cells, helping to maintain their normal blood levels.

‌‌How much folic acid should I take?

The recommended amount of folic acid is 400 micrograms per day. Recommendations vary by country, for example, in Australia the norm is about 320 micrograms per day, and in the European Union it is 200-300 micrograms per day. In general, the upper limit of 1000 mcg is considered not to cause any side effects.

Despite established guidelines, folate or folic acid intake may be below recommended levels in some populations. According to the US Centers for Disease Control and Prevention, Americans get about 140 mcg of folate per day from fortified foods.

The World Health Organization (WHO) has set a folate requirement of 400-800 micrograms per day for women trying to conceive. Obstetricians often prescribe iron and folic acid supplements (such as prenatal vitamins) before and during pregnancy because of the importance of folate for fetal development. Most prenatal vitamins contain about 1 mg (1,000 micrograms) of folate, more than the recommended daily allowance.

‌‌Folate deficiency

Folate deficiency in the body and diet can be caused by a number of factors. First of all, this is an insufficient intake of leafy greens and vegetables or fortified grains, or not taking supplements. Certain diseases can interfere with the absorption of folate by the digestive system and lead to folate deficiency.

Excessive alcohol consumption can also cause folate levels to drop because alcohol impairs the body’s ability to absorb and store folate in the liver. Some medications for serious illnesses can also interfere with folate absorption, requiring supplementation.

Finally, folic acid supplements should be taken during pregnancy, as the process of cell division and growth is especially intense in the fetus immediately from the moment of conception.

‌‌Folate and Pregnancy

Folate is extremely important during pregnancy or when trying to conceive, as it is essential for the normal development of the spinal cord and brain of the fetus. In several studies, folic acid supplementation and prenatal vitamins have shown a 71% reduction in the incidence of neural tube defects during pregnancy.

In the first weeks of pregnancy, the fetus is an accumulation of cells, which at a certain moment begin to divide into clusters. Clusters create folds, some of which form the so-called neural tube, from which the spinal cord and brain eventually form.

Don’t wait until your first antenatal visit at 6-12 weeks pregnant to start taking folic acid. At this point, the main organs of the fetus are already developing, and starting folic acid supplementation will not help prevent a possible neural tube defect. To prevent it, it is critical for women to start supplementing with 400 micrograms of folic acid per day before trying to conceive.

Folic acid helps the body convert homocysteine ​​to methionine, an amino acid involved in protein synthesis. Homocysteine ​​is produced naturally when protein is broken down. At low levels, it does not cause problems, but its high level can cause serious problems with blood functions. It is believed that elevated levels of homocysteine ​​in women increase the risk of miscarriage, preeclampsia (late toxicosis), and even premature birth.

What causes an increase in homocysteine ​​levels? Methylfolate (the active form of folic acid) is involved in the conversion of homocysteine ​​to methionine (a harmless amino acid). If there is not enough folic acid for methylfolate to begin converting homocysteine ​​to methionine, homocysteine ​​levels may begin to rise.

Folic acid side effects

Folic acid supplements are generally well tolerated by the body. There is no clear evidence of side effects from their use in the medical literature. This means that folic acid itself is generally safe. There have been rare episodes of nausea, vomiting, or diarrhea with folic acid supplementation, but it is generally well absorbed by the body when taken alone.

When taking supplements, be sure to read the label and check for other vitamins, minerals, and herbs. They may have different recommended daily allowances than folic acid.

The big picture

The body stores 10–30 mg of folate in the liver, but this level can drop dramatically if the diet is deficient in folate and supplements are not taken. Consider supplementing with 400 micrograms of folate per day to make up for the deficiency.

Remember, cells are constantly dividing, and you can help them do so by taking folate supplements.

If you are trying to conceive or suspect you are already pregnant, start taking prenatal vitamins with folic acid or folate to prevent neural tube defects in the fetus. And most importantly, eat enough leafy greens and vegetables to maintain normal levels of folate and other vitamins and antioxidants in the body.

Sources:

1. Bhandari J, Thada PK. Neural Tube Disorders. In: StatPearls. Treasure Island (FL): 2021. https://www.ncbi.nlm.nih.gov/books/NBK555903/
2. Dietary Reference Values ​​for folate. European Food Safety Authority. https://www.efsa.europa.eu/en/efsajournal/pub/3893.
3. Folate (folic acid). Mayo Clinic. https://www.mayoclinic.org/drugs-supplements-folate/art-20364625. Published February 23, 2021.
4. Folate and Folic Acid in Pregnancy. American Pregnancy Association. https://americanpregnancy.org/getting-pregnant/infertility/folate-vs-folic-acid-68699/. Published April 23, 2021.
5. General Information About NTDs, Folic Acid, and Folate. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/folicacid/faqs/faqs-general-info.html. Published April 11, 2018.
6. Merrell BJ, McMurry JP. Folic acid. In: StatPearls. Treasure Island (FL): 2021. https://www.ncbi.nlm.nih.gov/books/NBK554487/
7. Vipercore-13. Folate. https://www.nrv.gov.au/nutrients/folate. Published January 1, 20050001

   Contents

   • Folic Acid – Vitamin B9
   • The importance of folic acid for the female body
   • Consequences and prevention of folic acid deficiency
   • Folic acid: indications for use
   • Contraindications to the use and side effects of folic acid
   • How to take folic acid correctly
   • Folic acid and contraception
   • The content of folic acid (Vitamin B9) in products

   Folic acid or B9 is one of the most important vitamins in the human body. Unfortunately, almost every person has a greater or lesser deficiency of this vitamin. Folic acid deficiency is most dangerous for pregnant women, as it can cause neural tube defects in the fetus. How to recognize folic acid deficiency, and what is its role in the body?

   Folic acid – vitamin B9

   Folic acid, B9 or acidum folicum, is an organic compound from the B vitamins. The name comes from the Latin word folium, which means leaf, and is found in food in the form of folates (folic acid salts). Therefore, the term vitamin B9 is often identified with a whole group of compounds (it has been established that theoretically there can be about 150 different forms of folic acid; in nature there are about 20 of them).

   Folic acid is found in the tissues of many plants and animals. It was first isolated in 1940s from spinach leaves. Physically, folic acid is a water-soluble substance of a light yellow color.

   The level of folic acid in the body drops when we live under stress, abuse coffee and alcohol, smoke, take acetylsalicylic acid and even some contraceptives. The body’s stores of folic acid are depleted due to malnutrition, inadequate diets, and rapid weight loss.

   Folic acid is an exogenous substance that enters the body with food because the body cannot produce it on its own (bacteria in the human digestive tract can produce it).

   The importance of folic acid for the female body

   Why do women need folic acid? The required level of folic acid in a woman’s body determines its proper functioning. The active form of B9 plays a key role in the metabolism of many amino acids, in addition to supporting the production of serotonin, which is one of the most important factors for healthy sleep and relaxation. How else is folic acid useful for the female body? Folic acid is responsible for the normalization of the nervous system, improves attention and memory, increases mental activity. In addition, it is involved in the production of digestive enzymes, supports the proper functioning of the liver, intestines and stomach.

   It has some preventive effect on the development of uterine and stomach cancer in women.

   Planning and pregnancy

   Vitamin B9 is an extremely important substance at the beginning of a child’s life. It is involved in the formation of the neural tube. It is on the basis of this structure that the brain and spinal cord of the baby develops. Vitamin B9 supplementation in women of reproductive age significantly reduces serious fetal abnormalities such as anencephaly (complete or partial absence of cerebral hemispheres) and spina bifida (malformation).

   Vitamin B9 is also an important ingredient for the proper development of the fetus in late pregnancy. Folic acid during pregnancy ensures a good condition of blood vessels and red blood cells, stimulates cell reproduction during a period of intensive growth, and prevents the development of anemia in a child. To maintain proper blood levels of B9, a nursing woman, as well as a pregnant woman, should consume 400 micrograms of folic acid in tablet form as a dietary supplement.

   For women over 40 and 50 years old

   Folic acid for women after 40 plays an important role in the proper functioning of the nervous system. This is due to its participation in the synthesis of adrenaline, norepinephrine and dopamine, which are key neurotransmitters for the body. Numerous studies have shown a correlation between folic acid deficiency and the development of disorders of the nervous system (depression, epilepsy, psychosis, dementia, as well as diseases of the spinal cord and peripheral nerves). In addition, vitamin B9helps to maintain the proper concentration of homocysteine ​​in the blood. An insufficient amount of folic acid in women after 50 years of age leads to an increase in the level of homocysteine, which may be involved in the development of atherosclerosis and neuronal degeneration. Consequently, cerebral ischemia, microinfarcts, vascular dementia, and Alzheimer’s disease may occur.

   Consequences and prevention of folic acid deficiency

   Folic acid deficiency in the body can contribute to anemia, degenerative disorders, cardiovascular disease, osteoporosis, and even cancer. In women in early pregnancy, B9 deficiencyincreases the risk of neural tube defects in the fetus.

   Side effects of folic acid deficiency in women:

   • Pale skin
   • Fatigue
   • Excessive hair loss
   • Dry skin
   • Headaches
   • Dizziness
   • Concentration problems
   • Insomnia
   • Alarm states
   • Mood swings
   • Digestive problems
   • Weight Loss

   The bioavailability of folic acid in our body depends on the type of medications taken and the overall health of the digestive system and gut microbiota. Interestingly, synthetic folic acid can be absorbed up to 100%, while its natural version is absorbed at a maximum level of no more than 80%. It is worth remembering that the correct use of folates by the body is supported by the presence of vitamins C and B12, as well as zinc. Folic acid is stored mainly in the liver, and its reserves in the body are 5-10 mg.

   Folic acid: indications for use

   Folic acid in the form of dietary supplements is one of the vitamins recommended for mothers and pregnant women, as well as people who cannot make up for folic acid deficiency through a normal diet.

   B9 nutritional supplements are recommended for women planning pregnancy, pregnant and lactating mothers using hormonal contraceptives, as well as for people who monitor the proper functioning of the hematopoietic system. Folic acid in combination with other B vitamins is prescribed to patients in case of diagnosing non-severe forms of anemia.

   Contraindications for use and side effects of folic acid

   Although some studies indicate that taking up to 5 mg of vitamin B9 per day does not provoke a toxic effect, it has been found that taking more than 1 mg of folic acid per day can cause abdominal cramps, diarrhea, rashes, sleep disturbances, irritability, confusion consciousness, nausea and other side effects.

   There is also concern that taking too much folic acid for a long time can cause serious side effects. Some research suggests that taking folic acid in doses of 800 mcg to 1.2 mg per day may increase the risk of heart attack in people with heart problems. Other studies show that taking such high doses for a long time can accelerate the growth of existing malignancies. In addition, excess folic acid during pregnancy increases the risk of asthma in the baby.

   Regarding contraindications to taking folic acid, the following factors are distinguished here: vitamin intolerance, acute B12 deficiency, the presence of cancers, anemia of a malignant type.

   How to take folic acid correctly

   The recommended dosage of folic acid is 400 micrograms per day. Doses of folic acid greater than 1,000 micrograms per day are not recommended.

   How to take folic acid? Folic acid requirements vary by gender, age, and the presence of systemic disease. Thus, the US Food and Drug Administration (FDA) has determined that the intake of folic acid in relation to the above factors should be 0.07–0.13 mg / day. For women planning pregnancy B9it is recommended to enter 12 weeks before conception. At the same time, the dose of folic acid for already pregnant and lactating women is 0. 4 mg / day. However, before taking B9, you should definitely consult your doctor.

   Folic acid and contraception

   Folic acid is compatible with all methods of contraception. Moreover, relatively recently, combined oral contraceptives have been synthesized, which contain folic acid. According to studies, this combination has a better effect on the skin, more effectively reduces the manifestation of PMS and depression.

   Folic acid (Vitamin B9) content in foods

   The main source of folic acid for humans is food. The intestinal microflora synthesizes only small amounts of vitamin B9, therefore, its intake from the outside is extremely important.

   Which foods contain the most folic acid? The main source of folic acid in the diet are dark green vegetables. It is found mainly in greens and vegetables such as spinach, parsley, broccoli, Brussels sprouts.

   Legumes are also a good source of folic acid. Among them, soybeans, white beans, peas and beans are the richest in B9. Folic acid can also be found in some nuts, such as peanuts, walnuts, and almonds. A large amount of folic acid is found in organ meats, mainly in beef and chicken liver.

   It should be remembered that an excess of folic acid does not cause much harm to the body, and is relatively well tolerated even at a dose of 5 mg. However, increased folic acid intake may mask vitamin B12 deficiency and pernicious anemia. Do not forget that taking any supplements requires prior consultation with a general practitioner or family doctor.

   1. Gorbachev, Gorbachev: Vitamins. Macro- and microelements. Handbook (Special Publishing House of Medical Books, 2011). – 432 p.
   2. Bitsadze V.O., Samburova N.V., Makatsaria N.A., Mishchenko A.L. Folate deficiency conditions in obstetric practice and the problem of their correction // Obstetrician, gin. and reproduction. 2016. V. 10, No. 1. S. 38-48.
   3. Ars CL, Nijs IM, Marroun HE, Muetzel R, Schmidt M, Steenweg-de Graaff J, et al.